Stony Brook Medicine’s health system, which, prior to COVID-19, had already grown from a two-hospital system to a four-hospital system with the inclusion of Eastern Long Island Hospital and Southampton Hospital, reflects a population of diverse and geographically spread patients of more than 1.4 million people in Suffolk County, New York.
Uses telehealth technology to connect specialists and physicians to areas of need, help monitor patients’ health status and behavior remotely, promote timely and efficient care, and help providers reach patient populations previously isolated.
The opportunities offered by telemedicine
Dr. Gerald J. Kelly, CIO of Stony Brook Medicine, said the continued use of telehealth in the health system continues to provide the opportunity to:
- Promote better access to care
- Increase the reach of the organization’s specialists and providers
- Reduce health care disparities and the costs of unnecessary transportation, visits, and readmissions
- Improve health outcomes by ensuring proper follow-up and better patient adherence and satisfaction
- Secure the institution as an academic health center using innovative biomedical technology
“In the beginning, one of the biggest challenges was determining what technology to use and what services would be most appropriate for telehealth,” Kelly noted. “The questions were: What platform could help us connect with patients regardless of their location? What platform could integrate with our electronic medical records and scheduling systems? What platform was easy and efficient for providers and patients to learn?
“We understood that telehealth would support our institution as a leading academic health center using innovative technology and data analytics in our clinical, educational and research efforts,” he continued. “To develop a strategy around digital medicine, a telehealth task force was first convened on May 22, 2017, and included key stakeholders in hospital and schools.”
The goal was to establish an infrastructure and strategy in launching the telehealth business at Stony Brook Medicine. The first strategic plan developed in 2018 has evolved to include support for the broader goals of the Stony Brook Medicine Clinically Integrated Network.
Accelerating technology adoption
“Although our efforts began with a few small pilot projects, during the pandemic Stony Brook Medicine, like many other health systems, immediately accelerated and scaled up the adoption of telehealth in March 2020,” Kelly recalled.
“This was necessary to meet the needs of our outpatients in more than 20 specialties; help ED folks triage when admitted to the hospital; and connect families with loved ones while in-person visits were prohibited to limit the exposure to the virus for the safety of all,” he added.
A strategic relationship with Microsoft was developing prior to the public health emergency and fast-forwarded in March 2020. Stony Brook launched using Microsoft Teams as its initial telehealth platform and visits accelerated from a few dozen per month to approximately 20,000 per month at the height of the pandemic.
Subsequently, through funding from a nearly $1 million Federal Communications Commission grant, the largest FCC funding of any health system on Long Island through the program, a more permanent technology was purchased from vendor Teladoc and was implemented as a standard platform. The platform was rolled out for use across all medical specialties, allowing visits to continue seamlessly, even when patients couldn’t leave their homes.
Smartphones for those in need
In addition to the purchase of Teladoc, the FCC grant enabled Stony Brook to purchase and distribute 200 iPhone 7S devices with one year of service to patients in need of remote patient monitoring. Through this initiative with Vital Care Services, which continues today, Stony Brook monitors 60 patients per month after discharge with pulse oximetry, blood pressure, vital signs and virtual visits.
“The Teladoc platform answered questions we had earlier in our exploration,” said Kelly. “Teladoc has a wide range of capabilities when it comes to video connectivity, is easy for both patients and providers to learn, and can integrate with our EHR and scheduling systems.
“Given the significant increase in the volume of digital visits during COVID, we focused on supporting the needs of clinical departments, providers, and patients as telehealth programs expanded,” he continued. “This support also included the creation of a stronger governance structure and the initiation of a comprehensive strategic plan for the expansion of telehealth services.”
Aside from the platform-specific questions Stony Brook had early on, prior to the pandemic, the biggest challenge had been getting broad and consistent buy-in for the resources to build the telehealth program. This raised questions about telehealth decision-making.
Generate enthusiasm and support
“Post-pandemic, these challenges are not completely eliminated, however, the Teladoc company-wide platform being used successfully has resulted in the enthusiasm and support expressed by both providers and patients,” he stated. Kelly.
“Teladoc provides 24/7 support that patients can access via bot, email and phone,” he added. “The platform features ‘Seamless Join,’ which means you don’t have to use an app to connect to a call. For some patients, this is important because they don’t know their app store password or how to download an app.”
With Teladoc, patients are encouraged to use your app, but not required. The Teladoc platform also features built-in translation services, patient intake and consent forms, and a branded app so patients know who they are connecting with.
Additionally, it is the same platform that serves Stony Brook inpatient services and enables providers to connect with patients at each of the health system’s four hospitals and in the outpatient setting.
Compliance and accreditation
“The enterprise-wide platform has also prompted further development of a robust telehealth compliance program and accreditation process, crisis management infrastructure, and further commitment to infrastructure development,” Kelly noted.
“Although we are using Teladoc for our enterprise platform, there are several noteworthy telehealth initiatives that Stony Brook organized and launched in Microsoft Teams during the pandemic that are still in use,” he added.
These include: a Champions of Wellness channel where posts provide local and national mental health resources and strategies for managing stress and virtual mindfulness and meditation sessions for faculty and staff. Stony Brook also has 24/7 counseling via telehealth, which was about to launch just before the pandemic, and is offered to students through Counseling and Psychology Services.
Stony Brook Medicine consistently provides approximately 10% of its monthly outpatient visits via telehealth, reflecting the stability of the service since the spikes seen in the early part of the pandemic.
Specialized consultations for hospitalized patients
“We have also successfully implemented specialized inpatient consultations, improving access to our geographically distant hospital partners and patients,” said Kelly. “We have reduced unnecessary transfers and ambulance trips by providing these consultations, and have allowed patients to stay closer to home.
“And we regularly monitor our telehealth program in more than 17 categories against national benchmarks for quality, access, experience and ease of use,” he continued.
Kelly and staff are very proud of both the continued work and advocacy of a group of champions who have overcome the ups and downs and continued forward with the goal of making telehealth a part of Stony Brook Academic Health Center, as well as the speed and breadth of Expansion during the pandemic.
Multiple processes and systems were put in place during a very hectic and difficult time, resulting in patients continuing to have access to the care they needed, Kelly said.
Focus on outpatient
“Today, the biggest focus of Stony Brook telehealth is virtual patient visits from our outpatient offices,” he said. “The current leader in virtual visits is mental health services through our Department of Psychiatry and Behavioral Health.
“Stony Brook Medicine now participates in the Association of American Medical Colleges-Manatt Health Telehealth Implementation Learning Collaborative,” he added. “This collaboration provides an advanced forum for participants to share their telehealth strategies and challenges and learn from each other about practical opportunities and methodologies used by others to integrate telehealth into daily clinical care and operations within an American medical school” .
At Stony Brook Medicine, telehealth supports the academic health center through the use of innovative technology and data analysis in clinical, educational and research activities.
“With advances in technology coupled with the current public health emergency, advancing our telehealth strategy makes our participation in this initiative imperative,” Kelly concluded.
Twitter: @SiwickiHealthIT
Email the writer: [email protected]
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